Objective: Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri.Design: Descriptive multi-country population-based study.Setting... Show moreObjective: Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri.Design: Descriptive multi-country population-based study.Setting: Ten high-income countries within the International Network of Obstetric Survey Systems.Population: Women with unscarred, preterm or prelabour ruptured uteri.Methods: We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri.Main Outcome MeasuresIncidence, women's characteristics, presentation and maternal and perinatal outcome.Results: We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2-0.3) in the unscarred uteri, 0.5 (95% CI 0.5-0.6) in the preterm uteri, 0.7 (95% CI 0.6-0.8) in the prelabour uteri, and 0.5 (95% CI 0.4-0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3-23.5%), three maternal deaths (0.84%, 95% CI 0.17-2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1-25.3%).Conclusions: Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in 'otherwise' scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions. Show less
This thesis focuses on the optimization of burn wound treatment by a multidimensional approach of burn wound management. The thesis comprises four parts. The first part examines the clinimetric... Show moreThis thesis focuses on the optimization of burn wound treatment by a multidimensional approach of burn wound management. The thesis comprises four parts. The first part examines the clinimetric properties (feasibility, validity and reliability) of three-dimensional imaging for measuring of wound surface area and percentage of the total body surface area (%TBSA). The second part evaluates treatments of partial thickness burns in paediatric patients. The third part is devoted to the FLAM study where two commonly used treatments (Flaminal® Forte versus Flammazine® for partial thickness burns in adult patients were compared with regard to clinical effectiveness, scar formation, qualify of life and cost-effectiveness. Finally, the course of different properties of scar formation was explored and factors that influence these properties of scar formation from the patients’ perspective were studied. Show less
Sramko, M.; Abdel-Kafi, S.; Geest, R.J. van der; Riva, M. de; Glashan, C.A.; Lamb, H.J.; Zeppenfeld, K. 2019
OBJECTIVES This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling.BACKGROUND The definition of ... Show moreOBJECTIVES This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling.BACKGROUND The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis.METHODS Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeted LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m(2) with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement.RESULTS The cutoffs for normal BV and UV were >= 3.0 and >= 6.7 mV for nonremodeled LV and >= 2.1 and >= 6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV.CONCLUSIONS This study found substantial differences in endocardial voltage of NIM in post-infarct patients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to etectroanatomic voltage mapping of LV. (C) 2019 by the American College of Cardiology Foundation. Show less
